Merli Manuela, Lucidi Cristina, Di Gregorio Vincenza, Falcone Marco, Giannelli Valerio, Lattanzi Barbara, Giusto Michela, Ceccarelli Giancarlo, Farcomeni Alessio, Riggio Oliviero, Venditti Mario
Gastroenterology, Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy.
Department of Infectious disease, "Sapienza" University of Rome, Rome, Italy.
PLoS One. 2015 May 21;10(5):e0127448. doi: 10.1371/journal.pone.0127448. eCollection 2015.
The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment.
Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients.
All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes.
One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections.
Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential.
多重耐药感染的传播在肝硬化患者中是一个持续增长的问题，尤其是在与医疗环境有接触的患者中。
我们的前瞻性研究旨在分析肝硬化患者多重耐药感染的流行病学、患病率和危险因素，以及经验性抗生素治疗的失败率。
纳入2008年至2013年间所有因微生物学确诊感染（MDI）而住院的连续性肝硬化患者。感染分为社区获得性（CA）、医院获得性（HA）和医疗保健相关（HCA）。如果细菌对至少三类抗菌药物耐药，则分类为多重耐药（MDR）；如果仅对一/两类敏感，则为广泛耐药（XDR）；如果对所有类抗菌药物均耐药，则为全耐药（PDR）。
在111例患者中观察到124例感染（15%为CA，52%为HA，33%为HCA）。尿路感染、肺炎和自发性细菌性腹膜炎最为常见。47%的感染由革兰氏阴性菌引起。51%的分离株对抗生素治疗多重耐药（76%为MDR，21%为XDR，3%为PDR）：抗生素预防的使用（OR = 8.4；95%CI = 1.03 - 76；P = 0.05）以及当前/近期与医疗系统的接触（OR = 3.7；95%CI = 1.05 - 13；P = 0.04）被选为独立预测因素。根据耐药程度，经验性抗生素治疗失败越来越频繁。在大多数HA和HCA感染中，治疗是不恰当的。
住院肝硬化患者中的多重耐药感染正在增加。更好地了解流行病学特征对于提高经验性抗生素治疗的疗效很重要。采取旨在减少多重耐药菌传播的预防措施也至关重要。
